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Unsolicited claim status request/response (277)

Updated on April 26, 2021

Pega Smart Claims Engine for Healthcare can generate an Unsolicited Claim Status Response (277). This transaction provides regular updates to the billing providers about the claims they have submitted to the application.

The Search277ForBillingProvider activity collects claim status information for non-paid claims based on the provider. A Response (277) file is created for each billing provider containing the information for all the claims for which payment has not been made.

By default, Pega Smart Claims Engine for Healthcare creates a Response (277) with a file name derived from parameters as defined in Step 10 of the Activity: GenerateBatch277File screen shown below. You can change this value for a more appropriate file name.

The Response (277) is created in the file location specified in the Destination path field of the Connect File: PegaX12XML277Out (screen below) connect rule.

The Response is now ready for selection. It is returned to the requesting system.

There is currently no trigger for this activity in Pega Smart Claims Engine for Healthcare. It is run on demand from the Search277ForBillingProvider activity.

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